Precision targeting of right dorsolateral prefrontal cortex with neuronavigated rTMS alleviates chronic insomnia via functional connectivity reorganization: a randomized neuroimaging trial

作者：Liang Gong, Xi Yang, Yuan He, Haoyu Li, Wen Zhou, Duan Liu, Bei Zhang, Chunhua Xi · 发表于：NeuroImage Clinical · 年份：2025 · DOI：10.1016/j.nicl.2025.103815 · 被引用次数：9 · 研究领域：Transcranial Magnetic Stimulation Studies、Sleep and related disorders、Digital Mental Health Interventions

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) offers a promising approach for the treatment of insomnia; however, the precise targets and underlying neural mechanisms remain unclear. This randomized, wait-controlled trial aimed to evaluate the clinical efficacy of neuronavigated rTMS targeting the right dorsolateral prefrontal cortex (DLPFC) in chronic insomnia disorder (CID) and to identify potential neural mechanisms associated with therapeutic outcomes. METHODS: Fifty patients with CID were randomized to receive 20 sessions of 1 Hz rTMS targeting the right DLPFC or to a waitlist control group. Stimulation coordinates were selected (MNI: 40,39,11) based on our previous neuroimaging meta-analysis, and were precisely localized using MRI-guided neuronavigation. Clinical assessments and resting-state fMRI were conducted before and after the intervention, respectively. Target-based functional connectivity (FC) analysis was used to map rTMS-associated network changes, while causal mediation analysis was used to examine the relationships between neural changes and clinical improvements. RESULTS: Compared to waitlist controls, the rTMS group showed greater improvements in insomnia and mood symptoms (all p < 0.001), with higher response rates (54.55 % vs. 9.09 %) and remission rates (68.18 % vs. 13.64 %). FC analysis showed significant group × time effects on the bilateral DLPFC, middle cingulate cortex, and right anterior cerebellar vermis. Mediation analysis indi...